For those audience members unfamiliar with Dr. Aseem Malhotra (who has been discussed previously on SBM, he is a British cardiologist who is currently conducting a campaign with like-minded people to halt the administration of COVID-19 vaccines in England and end all British COVID vaccination mandates. Once upon a time, he did support COVID immunization, but his views completely turned around once his father died of an apparent cardiac arrest at home. Though the cardiac arrest was compounded by an ambulance delay, Dr. Malhotra now describes this event as a vaccine injury. He is sincerely convinced that mRNA immunization has brought much more cardiac harm to the population than is being discussed in public, and that this harm was what killed his father. He is currently spending most of his publicly visible time asking for all COVID immunization to be halted. As a professional with similar training, I want to emphasize that the normal procedure for bringing forth a new biologic mechanism, practice guideline, or surgical technique, is to first conduct pre-clinical experiments to determine whether your idea is correct, then gradually move towards human clinical trials. For example, the surgical techniques for heart surgery on babies evolved over time to become the extremely safe techniques that are in use today in modern surgical suites. At multiple levels, surgeons and cardiologists argued over the best thing to do, and patients are safer during congenital heart surgery because of these debates. Russell Blalock, Helen Taussig, and Vivien Thomas were genuine pioneers in my field who helped invent the very first pediatric heart surgery (against steep opposition and dogma).
Very similar procedures have been followed for the mRNA immunizations. Multiple universities and research teams have been studying their safety and effectiveness since their release and have produced the necessary studies to substantiate their hypotheses. Those same universities and teams have used the same research and techniques to validate the major side effects. Dr. Malhotra, during his public appearances, has repeatedly claimed that people were experiencing unreported, deadly or nearly deadly cardiac events after mRNA immunization. His secondary claim is that there has not been sufficient research conducted specifically on this issue. Both of his core points are presented in the near absence of adequate evidence we normally expect from a practicing cardiologist. As of the writing of this article, he has made no verifiable efforts to corral together the research group, research funding, or multi-center collaboration to produce the basic science, clinical science, or epidemiological research to show that his beliefs are backed with peer-reviewed evidence (which is what the rest of us have done).
The lecture he delivered to the Friends House in Euston in November 2022 illustrates most of his major talking points. He uses a tactic widely employed by the antivax community, which is to weave in kernels of truth with outright falsehoods, which makes the task of deciphering his lecture for the non-medically trained reader much more difficult. His core motivation, in his own words, is to campaign against all forms of mRNA immunization after the death of his father, and he appears to be on a worldwide tour trying to share his point of view. The secondary message in his lecture revolves around descriptions of physician bias and his perceived lack of ability of physicians to review the medical literature.
Below is a list of 20 of his main talking points, and a discussion of the issues with his claims.
Claim 1: There is excessive physician bias due to pharmaceutical funding
Pharmaceutical companies are in one sense, a necessary evil in the medical ecosystem. The most basic reason for this is time. If physicians only saw patients, they can’t invent medications. Somebody’s got to do it. Physicians need to be seeing and diagnosing patients, but while some physicians (MD-PhD for example) are capable of doing new drug research, the research is extremely time intensive and not all physicians have all the skills or time necessary to discover a new antibody or new medication. Do some physicians interact with pharmaceutical representatives? Sure, and I will freely mention that cardiology training programs often have associations with companies that provide the devices or medicines prescribed by cardiologists. To address this widely recognized potential for conflicts of interest (COI), academic medical centers have several levels of safeguards to limit any undue influence. For example, Vanderbilt University lists how to determine if an employee has a conflict of interest and how to report it to the appropriate party, with equivalent systems throughout medical training and practice. Punishments in academic settings for failing to disclose such conflicts are actually quite severe. Also, patients in both England and the United States have the ability to search online for a particular physician, PA, or advance practice nurse and identify any reported financial conflicts of interest prior to any appointment. For British citizens, this website is helpful, and this is the equivalent for Americans. If you don’t like the conflicts of interest you are seeing, you can just walk away, and you can ask for a cheaper alternative if you think the medicine recommended is too expensive. I’ll freely disclose my financial conflicts of interest – a few restaurant meals from cardiology fellowship training days. I still don’t prescribe the medicines sold by the companies that provided the meals to myself and my fellow trainees because I don’t see the conditions those medications were used for. A blanket statement that “too many” or “all” physicians have an important COI is just inaccurate. It would be quite dangerous, for example, to refuse care for life-threatening heart failure because of a belief that too many hospital cardiologists are tainted by pharmaceutical funding. Generalizing Dr. Malhotra’s claim to this situation would literally put someone’s life in danger. Solution? I don’t actually know how to permanently stop pharmaceutical funding. One of the root causes here is that companies, led by CEOs, are always looking to profit.
Claim 2: Dr. John Ioannidis deserves the same acclaim as professor Stephen Hawking
Stephen Hawking, may he rest in peace, was a legend of an astrophysicist who studied in England. He is also partially famous because of his amyotrophic lateral sclerosis, which forced him to communicate with a machine. He gave us many breakthroughs in the world of astrophysics, and one of the behaviors of black holes is named after him (Hawking radiation).
John Ioannidis is a physician-scientist who graduated from a Greek medical school, whose specialty currently is data-based analysis of medical research (discussed many times on SBM). A lot of his claim to fame arose from his essay “Why most published research findings are false” (addressed by Dr. Novella here), which delineates how researchers from a wide spectrum of scientific disciplines aren’t doing all they could to design the most rigorous experiments. It was actually very beneficial for him to point out our fields’ intellectual blind spots and conflicts with the pharmaceutical industry. Unfortunately, when COVID came along his focus and opinions took a turn. He tried to criticize graduate student Gideon Meyerowitz-Katz in public without trying to address the substance of Meyerowitz-Katz’ arguments, and instead reverted to a variety of ad hominem attacks (including saying it is bad thing that a graduate student hasn’t published a similar volume of papers as Dr. Ioannidis). He underestimated the COVID infection fatality rate even early in the pandemic by trying to slip in non-representative samples. And then there was the Kardashian index paper. He has at this point, made multiple factual errors in his reporting of the COVID pandemic while failing to either realize or acknowledge he has done so. One of the occupational hazards of academic research is being wrong, but usually academic staff admit it. Doubling down is not a particularly ethical plan of action.
Professor Hawking on the other hand left a legacy of trying to help more graduate students choose physics. He worked very hard to advance his field. He did not let his disability degrade his will to survive. He has publicly admitted one of his mistakes and owned up to it.
Overall, conflating these two scholars is questionable at best, particularly given their very different fields of expertise, different attitudes towards trainees, and different attitudes towards changing direction once the empirical evidence changes.
Claim 3: Pharmaceutical companies engage in misconduct
This is something antivax people and provax people could get together on and jointly support – I don’t mind if the pharmaceutical companies get harsher penalties for getting things wrong (and especially when they are outright dishonest). Physicians get as frustrated as anyone else when things like the Vioxx scandal happen. However, it is not advisable to live in paranoia and think every medicine available is a pharma scandal just waiting to be discovered. Big pharma behaving badly does not mean all of their products are inherently harmful.
Claim 4: There is excessive mortality due to side effects of medications
A form of iatrogenic harm (caused by the treatment rather than the disease), this is a genuine problem in medicine and the scale/scope of the problem is an area of active debate. Some things in medicine, like the physics of the heart, are not up for debate; medication side effects should be researched and discussed. It is not accurate to imply that physicians are letting this issue fall by the wayside and actively ignore it. Physicians are trained to try and sort out side effects when starting medications, and recruit the assistance of the pharmacist when necessary to try to reduce the harms of individual and combined medications. Computerized medicine entry systems try to automatically alert physicians to major side effects. Some areas of medicine are devoted specifically to this problem. As is typical, people hostile to traditional medicine love to distort this out of context, so here is some context. A practical guide from Duke University demonstrates some of the efforts (and specific ways) healthcare systems and workers are trying to reduce iatrogenic harms of medications.
Claim 5: 800 000 patients may have died after taking beta blockers, therefore one should be highly skeptical of all cardiac medications
The context here is that in 2014, the European Society of Cardiology recommended patients with coronary artery disease or those who had suffered a heart attack take beta blockers after surgeries that did not involve the heart. The thinking was to decrease demand on the heart in order to avoid postoperative heart attacks in those who came to the hospital with pre-existing heart disease. However, subsequent investigations found that some patients did in fact suffer severe side effects from this approach. The person who recommended this practice was a physician by the name of Don Poldermans, who was later academically punished when his conflicts of interest were discovered (you can see the links with other points raised by Dr. Malhotra). The European Heart Journal, which published the work, quickly responded and retracted the article. Furthermore, the actual figure of 800 000 deaths may itself be an overestimate. If one delves more deeply into the research that claims to have demonstrated beta blockers harm patients, an experienced cardiologist would quickly see that the beta blocker doses used were likely too high. Current cardiology guidelines in both Europe and the United States recommend efforts to minimize perioperative risk in patients with heart disease, where one of the ways this can be accomplished is by using lower doses of beta blockers, in moderation. It would be seriously incorrect to conclude that this research means patients should “be scared of all the beta blockers all the time”. It would also be seriously incorrect to avoid mentioning all the checks and balances that resulted in the correction of the beta blocker policy.
Claim 6: Physicians should bear much more responsibility for overmedication and poor patient lifestyle
I challenge any audience member to find me a physician who directly recommended an unhealthy lifestyle to a patient. Some medical conditions like seizures, do not have simple cures, and require daily medication (another oversimplification by Dr Malhotra). It is not the patients fault that they may need daily medication. In clinical practice, the actual action of helping a patient achieve a more healthy lifestyle involves figuring out what the patient is willing to do, identifying any relevant socioeconomic barriers, deciding on an initial action plan, and engaging in followup. It is a long and complicated process, and anyone who has tried to quit smoking, lose weight, or exercise more, will have personal experience in how difficult it can be to make changes like these. Sometimes we can’t have a full and complete discussion, purely because of time. Would I like to teach someone how to cook a Middle Eastern fattoush? Sure! But I can’t necessarily do this for every appointment I have with a patient. One would assume a cardiologist like Dr. Malhotra would be aware of all the socioeconomic barriers to achieving a healthier lifestyle, but in the lecture he chose to gloss over those things and replace it with physician bashing. Not helpful. One should absolutely try to lead a healthier lifestyle, and many physicians are ready to help! However, it is not as simple as just flipping a switch. Leading a healthier lifestyle should be the default choice, and one does not need to purchase the services of a cardiologist to do this. In the United States, a registered dietician is an example of a healthcare professional who can help improve eating habits.
Claim 7: Absolute risk reduction is the ideal way to describe immunization benefit, not relative risk reduction, and this is intentional exaggeration of vaccine benefits
Insisting on reporting only the absolute risk reduction of disease harms due to vaccines is an old antivax tactic because the absolute risk reduction is mathematically always a smaller number than the relative risk reduction, and this supports the antivaccine narrative better. However, it is just two different ways of presenting the same outcome (amount of people who had less disease due to immunization). I won’t delve into the detailed mathematics, but take a real life example – let’s say you want to compare the number of apples in the refrigerator on one day versus another day. You have 20 apples to begin with, and you eat two. You’ll end up with 18 apples, but this can be expressed as either a 2 apple reduction, or a 10% reduction in apples. Its just two different perspectives. Two is smaller than ten, but one number is not intrinsically more conspiratorial than the other. If you require a discussion on this before you will consider vaccination, bring the journal article to the office visit! Just be prepared to conduct this discussion over more than one visit, because it takes time. Also, not all patients care for informed consent involving individual analysis of journal articles. While this topic may be new to many antivaccine activists, immunization epidemiology has always used the RRR. A big reason this is the case is because it does not depend on the amount of the pathogen in circulation.
Claim 8: Citizens all over the world are overmedicated with cardiac medications, so one should take all efforts to stop cholesterol lowering medication
Coronary stents are placed due heart attacks, or preventatively when one or more arteries of the heart become dangerously narrow. While the narrowing is physically relieved by the stent, issues with clotting, inflammation, and cellular dysfunction are not, and addressing these issues generally requires long-term medications. If there were a one-stop-shop mechanism to switch off that dysfunction with one pill, one time, that would be awesome, and I would reach for it. There is no such pill at the moment. Coronary artery disease is a mixture of high cholesterol, abnormal function of, and abnormal inflammation in, the arteries of the heart. However, removing medications entirely goes against shelves and shelves of research. The abnormal molecular processes do not stop just because you had a heart stent. One could tweak the medicines to be as few as possible, but taking them all away is highly dangerous. If you want to show that your favorite supplement is better than statin, do the experiment! It is not acceptable to just proclaim you are going to stop statins just because of your belief system. In addition, there are several genetic factors that predispose people to high cholesterol that will place patients at risk of an early heart attack, and all the red rice yeast in the world won’t bring their cholesterol down to a safe level.
Claim 9: Obesity – it’s the patient’s fault!
It was not necessary to delve into patient blaming in the lecture. There are multiple metabolic, socioeconomic, genetic, and medical causes of obesity that have their own entire fields of medicine that study them. This is not one simplistic issue. Obesity is rising in many countries, however it takes a systematic approach to help each individual patient.
Claim 10: Hospitals serving fast foods is making the problem worse
Here I completely agree with Dr. Malhotra – get fast food out of the hospitals! Hospitals should set a good example to their patients, and support healthy lifestyles as much as possible.
Claim 11: Steven Gundry’s PULS abstract demonstrates that mRNA immunization causes coronary artery harm
Steven Gundry is a former cardiac surgeon who has turned to providing a private outpatient concierge practice. I discussed how he tried to use a coronary inflammation test known as “PULS” to measure heart artery inflammation in patients after COVID vaccination. While his hypothesis and intentions were reasonable, he designed a study with none of the usual statistical controls and safeguards expected of such a study, based on a test that had not been validated in the population that it was used on. This is not acceptable and should not have been praised by Dr. Malhotra. In cardiology we frequently use tests and medicines outside their original design specifications (such as digoxin in pediatric heart failure), however this is not done in the complete absence of peer-reviewed evidence. The PULS test was designed to test heart artery inflammation but it has never been validated to assess the impacts of immunization. If one undertakes an injection designed to active the immune system, one should expect to find lab test results reflective of that. At minimum, Dr. Gundry would need to repeat the test with a control group, which wasn’t even done in the original abstract. If Dr. Malhotra and colleagues sincerely think the entire world failed to catch vaccine-accelerated coronary atherosclerosis, coronary hypersensitivity, myocarditis, and dilated cardiomypathy, do the study to show that we all missed it! Solely proclaiming this is true does not make it true.
Claim 12: Dr. Clare Craig, anti-COVID-19 vaccination activist, reviewed Dr. Malhotra’s article in the Journal of Insulin Resistance, therefore his claims are more credible
Dr. Craig is a British pathologist who is one of the members of the UK HART (Health Advisory and Recovery Team) group, an organization who has one stated goal of abolishing all COVID vaccinations. She is hostile to COVID immunization, but uses articles that debunk her point to try to prove her point. She is tied to the idea that COVID vaccinations cause COVID (which is biologically not possible). She thinks people can’t die of COVID, which is a hard no. She thinks the elderly don’t catch COVID, which is another hard no. If she is the person you are consulting to strengthen your position, that suggests your position is not a good one.
Claim 13: There is an unexpected association of COVID with less heart disease
Not only does this claim by Dr. Malhotra go against the weight of the evidence (much of which is independent of Pfizer and Moderna), it is cherrypicking one sentence in a single article and hoping the reader doesn’t pay attention to the next sentence which says this result was likely affected by sampling bias. While such a tactic may work in a courtroom, it does not work in the court of scientific peer review. Dr. Malhotra also completely ignores the overall conclusion of the article, which is very clear and consistent with the results of other research groups (a pretty good sign that their work is good).
This is a man who preaches research integrity in one breath, and attempts to distort an article in the very next. Sleight of hand is not cool.
Claim 14: There should be more praise for the analyses of Peter Doshi that show immunization harm
Doshi has been a frequent subject of articles at SBM. He has produced many re-analyses to try and show that vaccines are harmful, but he had to use statistical trickery to reach these conclusions. Reanalyzing statistics until they show the point you prefer is not an activity that credible and unbiased researchers do. One technique used in Doshi’s articles is discussed here.
Claim 15: The Israeli heart attack study shows a significant rise in heart attacks after COVID immunization
A research group analyzed emergency telephone calls to Israel’s National Emergency Medical services and found an association between 16-39 year olds and calls for cardiac arrest and possible heart attacks. This has been trumpeted as evidence for heart harms related to COVID-19 vaccines, however remember that the myocarditis issue in teen boys and young men has been well characterized now. If you don’t want to get vaccinated due to this, please at least consider all the multi-organ system issues that COVID can create. One big issue in drawing sweeping conclusions from that study is that there was no effort to look at final diagnosis codes through chart review – so everything from congenital heart disease to aortic dissection could have been included. It should not have to be said, that COVID immunizations cannot cause a heart defect that you were born with. I do advise anyone with chest pain after COVID immunization to seek immediate medical attention, however the study cited is not capable of demonstrating changes in the rate of heart attacks after COVID immunization.
Claim 16: Florida Surgeon General Joseph Ladapo’s Department of Health study demonstrates immunization harm
That is a hard no. This anonymous “study” (discussed on SBM) released by the Florida Surgeon General is actually contradicted by the data they used in the study. If they had actually performed a proper risk-benefit analysis, the study would have clearly shown the benefits of vaccination. Instead, it only described risks of vaccination – which we already know and have adjusted for. If Dr. Ladapo had performed even the briefest moment of reflection, he would have realized this, but he is only interested in supporting his narrative.
Claim 17: Disease-derived immunity is consistently superior to immunization-derived immunity
This is repeatedly oversimplified as “natural immunity is better”. Here is the opinion of someone actually trained in the subject, with all the necessary nuance and complexity. Some people who are infected don’t even gain any immunity! The correlates of protection are an active area of ongoing research. Based upon the research of the Crotty lab, a combination of immunity gained by infection plus immunization is superior to either alone. One of the core issues is that SARS-COV-2, like its cousin coronaviruses, changes very quickly due to the genome having not particularly good error checking. As a result, many proteins on the viral surface change, and the immune system may have difficulty recognizing the altered viruses. This is the reason that even hybrid immunity is not a brick wall against future infection. Researchers like Professor Akiko Iwasaki are attempting to lead efforts to improve COVID immunizations for exactly this reason.
Claim 18: COVID-19 immunization adverse events are under-reported and deserve more care/ recognition
I have yet to witness Dr. Malhotra engaging in the medical care of anyone genuinely afflicted by a COVID-19 immunization adverse event, but I hear a lot of talk about supporting charities. There seems to be no obvious publicly available information demonstrating that these charities actually funded peer-reviewed COVID immunization injury research. I would be happy to be advised otherwise on this claim. Can he show us that he really “walks the walk” and can cure someone of tinnitus, neuropathy, or postvaccination myocarditis/pericarditis caused (or allegedly caused) by the COVID-19 vaccines? There are multiple streams of evidence, such as this one, that show claims of increased adverse events are actually showing a lack of understanding (and sometimes misrepresentation) of the data. Programs like the NVIC in America provide recognition and support to patients for whom there is actual evidence supporting the claim they were injured by a vaccine (more thoughtful discussion of this topic can be found on Dorit Reiss’ blog). However, this needs to be based on reasonable evidence showing a consistent link between vaccination and adverse outcomes – not a series of presentations in the Euston Friends House. An example of a research group of pediatric cardiologists who is showing genuine support to patients who sustained post-vaccination myocarditis is here, to contrast the vast difference in signalling support versus actually providing it. Those cardiologists actually saw patients, performed MRIs, did multi-center research, and helped patients recover from myocarditis. No similar research is known to have been produced by Malhotra and his colleagues.
Claim 19: Bill Gates should focus on non-communicable diseases
Even a very simple fact check would reveal that the Bill Gates Foundation is already funding research in this arena.
Claim 20: Aseem Malhotra’s father’s death is highly suspicious evidence that all mRNA immunizations are causing harm
Dr. Malhotra’s father, Dr. Kailash Chand, was a physician himself. He was also a patient known to have significant coronary artery disease and was at risk of heart attacks. His death due to cardiac arrest was reported at the BBC, and was explicitly described by Dr. Malhotra as likely being related to the ambulance delay (a genuine problem in the British NHS at the moment that deserves its own article). However, Dr. Malhotra is now trying to spin this as a vaccine injury. If someone thinks the vaccination is causing heart attacks, myocarditis, or sudden heart artery narrowing several months after the date of the immunization, do the research! If he thinks there is undiagnosed sudden coronary inflammation or accelerated atherosclerosis, do the research to see if this is the case! We at least need to see an animal study/ basic science study, and if this experiment supports the idea, then it should be followed by a human study. Physicians have never been allowed to make hypotheses and present them as truth in the absence of experimental evidence. In addition, due to his opposition to statin medication Dr. Malhotra also explicitly talked his dad out of taking medications after heart stent procedures to relieve a coronary narrowing, which goes against the shelves of research mentioned above. The precise medications that were meant to relieve heart artery inflammation and reduce possible clots were removed in a patient who probably really needed them. Dr. Malhotra even said on TV that he does not understand why a “healthy guy” was found to have coronary artery disease on autopsy. A piece of information that cardiology trainees learn early on is that older citizens have a relatively high prevalence of heart artery narrowings of varying degrees, much more so than in children. Silent heart attacks and heart attacks with no warning are a significant ongoing issue in the world of cardiology.
If the belief is that the immunization associated SARS-CoV-2 spike protein is causing hypercoagulability, show us some immunofluorescence proving that vaccine spike is there! Show us an abnormal thromboelastograph in real patients with the clots you believe are there! Show us a T-cell or cytokine assay revealing a previously unknown behavior of the immune system! Physicians have never been permitted to declare that something is true “just because”. We have never been permitted to stop short of a systematic analysis, like what Dr Ryan Cole did with the thrombi described in the “Died Suddenly” video. Cardiologists expect other cardiologists to provide a biologically plausible mechanism or defend their claims with clinical research. That’s how we’ve produced all the other evidence-based guidelines that currently serve patients. The rules of how to advance medicine don’t provide special treatment only to certain cardiologists.
Conclusion: Dr. Malhotra’s claims are not based on good evidence
Dr. Malhotra’s claims generally lack strong evidence to support them. They seem to be based on pre-existing beliefs and a narrative he is trying to advance, not the peer-reviewed literature. This is why the quality of evidence provided to the end-user is extraordinarily important. For all these reasons, please, please take the lecture, and all his future presentations on the same topic, with a grain of sodium-free salt substitute.